Radiography — Referral for a Chest X-ray in a Patient with a Persistent Cough
A GP writes a routine referral for a chest X-ray for a 52-year-old ex-smoker with a 6-week productive cough and two episodes of haemoptysis. This beginner case requires selecting the key clinical information that justifies the referral and stating the clinical question clearly.
Letter type
Referral
Write to
Radiology Department
Target length
150–170 words
The case notes
Patient: Mrs Patricia Nkosi, 52 years old; ex-smoker, quit 5 years ago (30 pack-year history); works as a school administrator
Presenting complaint: Persistent productive cough for 6 weeks; sputum: yellow-green; two episodes of blood-stained sputum in the past 10 days (haemoptysis)
Examination: Chest clear on auscultation today; temperature 37.2; no dyspnoea at rest; no weight loss; no lymphadenopathy
Investigations: No imaging in the past 5 years; FBC normal; CRP 14 (mildly elevated); no sputum culture sent yet
History: No prior TB, bronchiectasis or lung disease; no recent foreign travel; no relevant family history
Clinical question: Chest X-ray to investigate haemoptysis and persistent productive cough in an ex-smoker — to exclude an underlying pulmonary lesion
Task: Write a routine referral for a chest X-ray to the radiology department, providing the key clinical information and the clinical question.
Writing task
Write a routine referral for a chest X-ray to the radiology department, providing the key clinical information and the clinical question.
What to include, what to cut
The hardest mark to win is selection. The same case notes contain decision-relevant facts and distractors. Here is what an examiner expects to see in a Grade B letter for this scenario, and what should be left out.
Include
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30 pack-year smoking history, quit 5 years ago
Smoking history is the single most important risk stratification factor for a chest X-ray referral for haemoptysis. A 30 pack-year ex-smoker requires imaging; a young non-smoker with the same cough may not. State it first.
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Haemoptysis: two episodes in 10 days, blood-stained sputum
Haemoptysis drives the urgency of the referral. Quantify it: 'two episodes of blood-stained sputum over 10 days' gives the radiologist the clinical context to triage the request and to look for specific findings on the X-ray.
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The clinical question: to exclude an underlying pulmonary lesion in the context of haemoptysis and smoking history
The clinical question tells the radiologist what the GP is concerned about. A chest X-ray referral without a clinical question is reported generically; one with a specific question gets a targeted report.
Leave out
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The social history (school administrator, no travel)
Not relevant to the chest X-ray protocol. Foreign travel would be relevant only if TB were the clinical concern — it is not the primary concern here.
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The CRP result and the FBC
Normal FBC and mildly elevated CRP are background context. 'No current systemic signs of malignancy or infection on bloods' in one clause — or omit it.
Criterion in focus · Conciseness & Clarity
A routine chest X-ray referral is a short clinical communication. The minimum information is: the investigation requested, the patient's clinical history relevant to that investigation (smoking history, haemoptysis, cough duration), and the clinical question. A 200-word chest X-ray referral with full social history and investigation results is disproportionate. The skill in this beginner case is selecting from the clinical notes: haemoptysis + smoking history + clinical question. Everything else is background.
Now write the letter — and find out what is blocking your Grade B
Write a 150–170 words referral letter from these notes, paste it into the free checker for an instant read, then submit it for a human grade against all six criteria. Dr Mariam's team returns line-by-line feedback, from $12.